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United States Intervenes in Home Health Care Fraud Case

Posted 05/30/19

Doctor Hand Taking Money from Patient's Hand

Last week, the United States intervened in a lawsuit brought against Florida-based Doctor’s Choice Home Care and its two owners. The Department of Justice alleged that the company bribed doctors to refer patients in violation of the federal Anti-Kickback Statute and Stark Law. Both laws prohibit medical providers from paying or receiving kickbacks in connection with government-funded health care...

Tagged in: Anti-Kickback and Stark, FCA Federal, Government Decision, Home Health and Hospice, Whistleblower Case, Whistleblower Eligibility,

Intermountain Settles Dispute Pending Before Supreme Court, Leaving 9(b) Ambiguity Unresolved

Posted 05/24/19

Earlier this month, a Utah-based hospital chain announced it would settle whistleblower Dr. Gerald Polukoff’s case alleging the hospital performed unnecessary heart surgeries on Medicare patients, thereby overcharging the federal government in violation of the False Claims Act (FCA). Defendant Intermountain Health, the largest healthcare provider in the Intermountain West, had petitioned the U.S. Supreme Court to...

Tagged in: Court Decision, FCA Federal, FCA Pleading, Healthcare Fraud, Hospital Fraud, Lack of Medical Necessity,

Question of the Week — Should institutions return past donations from Big Pharma executives and their family members implicated in the opioid crisis?

Posted 05/23/19

The New York Times recently reported that the Metropolitan Museum of Art has decided to stop accepting gifts from members of the Sackler family linked to Purdue Pharma, the maker of OxyContin, one of the drugs at the center of the opioid epidemic that has killed more than 200,000 Americans in the past two decades. The Met’s decision follows that of other museums and universities, including the Tate Modern, the...

Tagged in: Healthcare Fraud, Pharma Fraud, Question of the Week,

Question of the Week — Should the CEO Be Held Accountable?: Lessons from the Insys verdict.

Posted 05/10/19

Handcuffed business-leader walking through jail.

In a shocking first, a federal jury has convicted an opioid-company CEO and other top executives of a criminal racketeering conspiracy. Insys founder and chairman John Kapoor and four other executives bribed doctors to overprescribe a highly addictive fentanyl painkiller, and ran a phony call-center to defraud insurance companies into paying for the expensive drug. Although the company itself had already paid over...

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Defendants, Dosage Fraud, Healthcare Fraud, Lack of Medical Necessity, Off-Label and Unapproved Use, Pharma Fraud, Question of the Week,

Catch of the Week — Pharmaceutical Company Allegedly Bribed Doctors with Trips to the Kentucky Derby

Posted 05/8/19

Cartoon of Sick Monkey and Horse Doctor Doing Check-Up

A recent settlement between the Department of Justice and US WorldMeds (“USWM”), show how creative, and how luxurious, kickbacks allegedly paid to physicians can be. The company, a pharmaceutical manufacturer, agreed to pay $17.5M to resolve claims that it violated the False Claims Act by paying kickbacks to patients and doctors by boosting sales of two of their drugs, Apokyn (a drug used to treat Parkinson’s...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Importance of Whistleblowers, Whistleblower Case, Whistleblower Rewards,

Catch of the Week — Florida Hospital Chain CEO Settles False Billing Allegations

Posted 05/3/19

Emergency Room Hospital with Night Lights On

This week’s Catch of the Week highlights former hospital executive Gary D. Newsome’s settlement resolving false billing and kickback allegations. From 2008 to 2013, Newsome served as CEO of Naples, Florida-based hospital chain Health Management Associates, LLC (HMA). He will pay $3.46 million to resolve federal prosecutors’ claims that HMA, under his leadership, pressured doctors in the emergency department to...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Hospital Fraud,

Healthcare Fraud also Harms Private Insurers - and Whistleblowers can Help

Posted 04/25/19

Health insurance forms, stethoscope, calculator and dollars

Whistleblowers with information about healthcare fraud look first to the False Claims Act, and the impact that healthcare fraud has on Medicare, Medicaid, and other government healthcare spending. But, healthcare fraud that harms private insurance companies – as opposed to government payors – also attracts government enforcement attention. Several recent criminal prosecutions in Texas and elsewhere...

Tagged in: Healthcare Fraud, Private Insurance Whistleblower Reward Programs,

DOJ Announces Criminal Indictments in International Health Care Fraud Scheme that Caused $1.2 Billion in Medicare Losses

Posted 04/12/19

The U.S. Department of Justice announced this week that it had issued criminal indictments against two dozen individuals in one of the largest health care fraud schemes in U.S. history. The indictments target an alleged scheme involving the payment of illegal kickbacks and bribes by durable medical equipment (DME) companies in exchange for the referral of Medicare beneficiaries by doctors working with fraudulent...

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Medical Devices and DME,

Baltimore-Area Hospital Chain Pays $35M to Settle Kickback Claims

Posted 03/28/19

MedStar Health, a health system in Maryland and Washington, DC, and two of its hospitals have settled allegations that they violated the False Claims Act by violating the Anti-Kickback Statute. The settlement is not a determination of liability. It settles specific allegations that MedStar paid kickbacks to MidAtlantic Cardiovascular Associates, a cardiology group based in Maryland, in exchange for...

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Whistleblower Case,

Constantine Cannon Attorneys Gordon Schnell and Leah Judge Published in McKnight’s Senior Living on the DOJ's Recent Elder Fraud Sweep

Posted 03/27/19

Constantine Cannon attorneys Gordon Schnell and Leah Judge published an article in McKnight’s Senior Living discussing the Department of Justice’s recent elder fraud sweep. The sweep involved more than 260 million defendants nationwide who were accused of running scams to fleece the elderly out of nearly $750 million. The article explains that the sweep is part of a broader agenda to enforce laws that protect...

Tagged in: CC Lawyers, FCA Federal, Healthcare Fraud,

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United States Intervenes in Home Health Care Fraud Case

Intermountain Settles Dispute Pending Before Supreme Court, Leaving 9(b) Ambiguity Unresolved

Question of the Week — Should institutions return past donations from Big Pharma executives and their family members implicated in the opioid crisis?

Question of the Week — Should the CEO Be Held Accountable?: Lessons from the Insys verdict.

Catch of the Week — Pharmaceutical Company Allegedly Bribed Doctors with Trips to the Kentucky Derby

Catch of the Week — Florida Hospital Chain CEO Settles False Billing Allegations

Healthcare Fraud also Harms Private Insurers - and Whistleblowers can Help

DOJ Announces Criminal Indictments in International Health Care Fraud Scheme that Caused $1.2 Billion in Medicare Losses

Baltimore-Area Hospital Chain Pays $35M to Settle Kickback Claims

Constantine Cannon Attorneys Gordon Schnell and Leah Judge Published in McKnight’s Senior Living on the DOJ's Recent Elder Fraud Sweep

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